Effect of conventional diuretics and angiotensin enzyme inhibitors on some renal functions in converting liver disease

ABSTRACT

Advanced liver disease is associated with a high incidence of renal failure and the rate of diuresis in non azotemic cirrhotic patients with ascites should not exceed the maximal rate of reabsorption of ascitic fluid to avoid plasma volume contraction and renal hypoperfusion. The reduction of markedly elevated angiotensin II production by an angiotensin converting enzyme inhibitor [Captopril] could suppress hyperalodosteronism without impairment of renal functions. On this assumption captopril could be useful in treatment of ascites. This study was performed on 15 non azotemic patients with ascites. They were given diuretics daily [Furosimide 40 mg once per day, and spironolactone 25 mg t. d. s.] for seven days. This was followed by the addition of captopril 50 mg per day in two divided doses to the previously used diuretics for seven days more. Fractional sodium excretion and creatinine clearance were measured before treatment, after giving diuretics for seven days and at the end of the study. Before treatment nonazotemic patients with ascites showed low fractional sodium excretion value and creatinine clearance. Both parameters were improved after the use of conventional diuretics. Whereas the addition of captopril was followed by significant decrease of the creatinine clearance while the fractional sodium excretion showed no significant change compared to the results obtained after the use of diuretics alone. One could conclude that the use of furosimide and spironolactone in non azotemic cirrhotic patients with ascites is effective and is not followed by impairment of renal functions. Whereas Captopril administration did not increase the fractional sodium excretion and resulted in decrease in creatinine clearance